Provider Demographics
NPI:1093249922
Name:VIRGINIA LEE PRATT
Entity Type:Organization
Organization Name:VIRGINIA LEE PRATT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWMER
Authorized Official - Prefix:MS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-375-0294
Mailing Address - Street 1:777 QUARTZ AVENUE
Mailing Address - Street 2:PMB 7714
Mailing Address - City:SAMDY VALLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89019
Mailing Address - Country:US
Mailing Address - Phone:702-305-9475
Mailing Address - Fax:
Practice Address - Street 1:2424 POLONA ST
Practice Address - Street 2:
Practice Address - City:SANDY VALLEY
Practice Address - State:NV
Practice Address - Zip Code:89019-1769
Practice Address - Country:US
Practice Address - Phone:702-305-9475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20161363095172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty